Uterine Inversion : a Case Report

The puerperal uterine inversion is a rare and severe complication occurring in the third stage of labour. The mechanisms are not completely known. However; extrinsic factors such as oxytocic arrests after a prolonged labour; umbilical cord traction or abdominal expression are pointed. Other intrinsic factors such as primiparity; uterine hypotonia; various placental localizations; fundic myoma or short umbilical cord were also reported. The diagnosis of the uterine inversion is mainly supported by clinical symptoms. It is based on three elements: haemorrhage; shock and a strong pelvic pain. The immediate treatment of the uterine inversion is required. It is based on a medical reanimation associated with firstly a manual reduction then surgical treatment using various techniques. We report an observation of a 25 years old grand multiparous patient with a subacute uterine inversion after delivery at home

Inversión uterina aguda / Acute inversion of the uterus

Se revisan 13 expedientes de pacientes que presentaron inversión uterina aguda. No se hallan factores predisponentes y/o precipitantes que por sí sólo explicaran este accidente del tercer estadío de la labor de parto. La hemorragia y el shock fueron los hallazgo clínicos más frecuentes. El diagnóstico inmediato de la inversión uterina facilita el tratamiento manual corrector del útero invertido, el cual se puede realizar sin necesidad de anestesia en la mayoría de los casos. La pronta reposición manual del útero invertido con el tratamiento simultáneo para el shock y hemorragia disminuyen los síntomas y complicaciones maternas.

Acute inversion of uterus

Twelve patients with acute inversion of uterus were admitted in the Department of Gynaecology and Obstetrics, Jinnah Postgraduate Medical Centre, Karachi over a period of 2 years from January 1997 to December 1998. The total number of deliveries during this period was 12866 making an incidence of acute inversion of uterus 0.093 percent [1:1072]. None of the patients were booked in Jinnah Postgraduate Medical Centre. All patients were admitted in emergency. Most common presenting features were shock in 75 percent [95 percent Cl, 45.8-93.21] of the admission and postpartum haemorrhage 66.6 percent, [95 percent CI, 37.7-88.4]. Three out of 12 patients were dead on arrival. The maternal mortality was found to be 25 percent